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Cyanosis, which occurs when the arterial concentration ofreduced hemoglobin exceeds 5 mg/mL, is seen with a righttoleft shunt, in which venous blood gains direct access to the arterial circulation. In contrast, patent ductus arteriosus, atrial septal defect, and ventricular septal defect are associated with lefttoright blood flow. It is characterized by fourchamber hypertrophy and dilation as well as right and leftsided severe heart failure. Because of the jellylike appearance and myxoid histology similar to that of some organized thrombi, the neoplastic nature of this lesion was debated for many years; however, it is now generally believed that myxoma is a true neoplasm. Due to its location, complications may develop due to physical obstruction ofblood fow through the mitral valve, resulting in symptoms of congestive heart failure. The term cor pulmonale refers to right ventricular hypertrophy caused by pulmonary hypertension secondary to disorders of the lungs or pulmonary vessels. Therefore, although in general, the most common cause ofrightsided heart failure is leftsided heart failure, cor pulmonale wth rightsided heart failure is due to an intrinsic disease originating in the lungs. Constrictive pericarditis can clinically mimic rightsided heart failure but is entirely unrelated to cor pulmonale. They are most often characterized by otherwise unexplained ventricular dysfunction, such as cardiac failure, ventricular enlargement, or ventricular arrhythmias. Anemia is a decrease in whole body red cell mass, a definition that precludes relative decreases in red blood cell count, hemoglobin, or hematocrit, which occur when the plasma volume is increased. Anemia ofpregnancy is not anemia but rather is a manifestation ofincreased plasma volume. Hematopoietic cell damage from infection, drugs, radiation, and other similar agents b. Within the first few hours ofacute blood loss, prior to hemodilution (compensatory increase in plasma volume), there may be no decrease in the hemoglobin, hematocrit, and red blood cell count because of a parallel loss of both red cells and plasma. Most often causes are menorrhagia orbleeding gastrointestinal lesions, such as carcinoma ofthe colon in the United States or hookworm disease in less developed countries. Increased iron requirement may occur during pregnancy; iron demands of the fetus can deplete maternal iron stores. It may also occur in infants and preadolescents who may outgrow borderline iron stores.
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To confirm these results and ex jects with mild depressive symptoms treated with prob tend them to individuals diagnosed with major depressive lemsolving therapy. At 6 months, the au Reviews have concluded that marital therapy is effective thors found a 2. Problemsolving therapy may have ital therapy trials, marital therapy had comparable efficacy advantages over usual care for homebound geriatric pa to individual psychotherapy for the treatment of depres tients with depressive symptoms (1141). Marital therapy problemsolving therapy were superior to supportive was superior in treating depressive symptoms, compared psychotherapy for depressed geriatric patients with major with minimal or no treatment. Another ened by methodological problems affecting most studies, study showed problemsolving therapy to have greater such as the small number of cases available for analysis in benefit than usual care in preventing depression (1142). Group therapy Results from individual studies suggest that the efficacy A mostly European body of research suggests that the in of marital therapy may depend on whether marital distress dividual psychotherapies validated in treating depression is present. Most of these studies have subjects with marital distress responded to marital therapy sought to demonstrate efficacy rather than exploring the than to cognitive therapy (88% vs. Analyses suggested that participants in treatment ically, whereas combined treatment had a small advantage showed significant clinical improvement. It is noteworthy psychotherapy and pharmacotherapy to treat patients with that patients receiving combined treatment experienced the depression, controlled studies conducted in the 1970s and earlier benefit that characterized the pharmacotherapy as 1980s did not consistently find a significant advantage for well as the later emerging benefit that characterized the routinely combining therapies, compared with one or the psychotherapy (362). Pa none of the early studies of combined therapy had the sta tients with chronic depression were thus more likely to tistical power to reliably detect such small effects. Consis benefit from combined treatment whether or not they had tent with this appraisal, a metaanalysis of these early a history of early adversity. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 97 domly assigned to strata that included both cognitive ther initial trial of a medication. Results at conducted a randomized controlled trial in which patients the end of 12 weeks of therapy indicated that cognitive ther meeting the criteria for major depressive disorder were apy was as effective as medication augmentation, although randomly assigned to receive placebo or citalopram in doses patients opting for combined pharmacotherapy responded of 10 mg/day (N=129), 20 mg/day (N=130), 40 mg/day faster (369). The percentages of patients lost to followup were ticed forms of psychodynamic psychotherapy. An informa 9% for placebo, 7% for citalopram at 10 mg/day, 2% for tive series of studies by one group of investigators in the citalopram at 20 mg/day, 2% for citalopram at 40 mg/day, Netherlands has helped to partly address this issue. The and 3% for citalopram at 60 mg/day (nonsignificant p val first trial compared outcomes of 167 outpatients with de ues). The 10 and 20mg doses were more efficacious than pression across 6 months of treatment with either algo placebo, but they were inferior to the 40 and 60mg doses rithmguided antidepressant pharmacotherapy alone or (p<0.
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Septic shock results in sis indicates he is suffering from acute tubular diffuse cortical necrosis of the kidneys, possi necrosis secondary to ischemia of the epithe bly as a result of a combination of vasospasm lial cells of the renal tubules. Due to their high metabolic rate, this syndrome generally present with abrupt these particular renal cells are particularly sen onset of oliguria or anuria accompanied by sitive to a drop in blood pressure such as that hematuria, fank pain, and hypotension. Another fuse cortical necrosis of the kidneys is gener common cause of acute tubular necrosis is a ally a much more severe disease than acute crush injury, in which the patient undergoes tubular necrosis, and can be diagnosed by ul rhabdomyolysis, or muscle death. Longtime diabetes the bladder, but these do not typically cause in this patient most likely caused a neurogenic obstruction. While passing stones Renal damage results when a bacterial urinary through the penile urethra can be painful, it tract infection is superimposed on the refux. The prostatic urethra grossly shows blunting and thickened dilation is not a typical location for renal stones to ob of the calyces and uneven scarring. While staghorn calculi above, there is a staghorn calculus flling caly may develop in the renal pelvis or calyces, they ces of kidney with chronic pyelonephritis; the do not typically produce obstructive symptoms cortex and medulla is atrophic and the calyces until they have grown to a considerable size. Staghorn calculi (struvite stones) can be seen in association with chronic infec 42. While diabetic patients is, more compound X is excreted in the urine are susceptible to acute pyelonephritis from in than is fltered at the glomerulus. Acute tubulointerstitial of the loop of Henle is poorly permeable to sol nephritis is often caused by hypersensitivity ute and instead allows passive effux of water to a drug (eg, methicillin, rifampin, thiazide from the fltrate. It is characterized by cannot undergo net reabsorption in the neph fever, rash, eosinophilia, and renal anomalies ron. However, if compound X un may be a sign of the chronic renal failure be derwent net reabsorption, its clearance would ing caused by chronic pyelonephritis, hyper Chapter 15: Renal Answers 411 tension alone would not cause the pathology 45. This has ease is a glomerular disease most frequently led to decreased renal perfusion, which has, in seen in pediatric patients. When patients respond to steroid therapy although a the glomerular fltration rate drops, there is an small fraction are at risk for chronic renal fail increase in sodium and water reabsorption in ure years later. An acute tubu driven by the electrochemical gradient created lar necrosis would present with renal failure in by this transporter. Signs and symptoms include rash, fever, eosinophilia, eosinophiluria, and elevated IgE Answer A is incorrect. Thiazide diuretics in trolled mainly by two factors: the hydration hibit the sodium chloride symporter in the dis state of the body and the level of kidney func tal convoluted tubules.
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Clinical evaluation of a newly developed endoscopic resection device (Rotoresect): physical principle and first clinical results. Diagnosis of Streptococcus pneumoniae lower respiratory infection in hospitalized children by culture, polymerase chain reaction, serological testing, and urinary antigen detection. Bipolar transurethral resection in salinean alternative surgical treatment for bladder outlet obstructionfi. The efficacy of terazosin for treating benign prostatic hyperplasia: a multicentre clinical trial. Effect of urethral compliance on the steady state pQ relationships assessed with a mechanical analog of the male lower urinary tract. A truncated precursor form of prostatespecific antigen is a more specific serum marker of prostate cancer. A precursor form of prostatespecific antigen is more highly elevated in prostate cancer compared with benign transition zone prostate tissue. Tumorassociated forms of prostate specific antigen improve the discrimination of prostate cancer from benign disease. Lower urinary tract symptoms suggestive of benign prostatic hyperplasia: latest update on alphaadrenoceptor antagonists. Update on the use of dutasteride in the management of benign prostatic hypertrophy. Nephronsparing surgery for renal cell carcinomais tumor size a suitable parameter for indicationfi. Cooled thermotherapy for the treatment of benign prostatic hyperplasia: durability of results obtained with the Targis System. Atorvastatin treatment for men with lower urinary tract symptoms and benign prostatic enlargement. Studies of the pathophysiology of idiopathic detrusor instability: the physiological properties of the detrusor smooth muscle and its pattern of innervation. Transition zone volume measurementis it useful before surgery for benign prostatic hyperplasiafi. Prostatespecific antigen and transition zone index powerful predictors for acute urinary retention in men with benign prostatic hyperplasia. The importance of prostatic measuring by transrectal ultrasound in surgical management of patients with clinically benign prostatic hyperplasia. Prediction of alpha blocker response in men with benign prostatic hyperplasia by magnetic resonance imaging. Clinical characteristics of alphablocker responders in men with benign prostatic hyperplasia. Urinary bladder involvement in patients with systemic lupus erythematosus: with review of the literature. Production of serumfree and total prostatespecific antigen due to prostatic intraepithelial neoplasia. Diagnostic accuracy of percent free prostatespecific antigen in prostatic pathology and its usefulness in monitoring prostatic cancer patients.